Provider Demographics
NPI:1962427377
Name:GRABOWSKI, SUSAN R (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:GRABOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18530 MACK AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3254
Mailing Address - Country:US
Mailing Address - Phone:313-655-4824
Mailing Address - Fax:313-886-3910
Practice Address - Street 1:18530 MACK AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3254
Practice Address - Country:US
Practice Address - Phone:313-655-4824
Practice Address - Fax:313-886-3910
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014996208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2555012374OtherBCBS PIN
MI2558217654OtherBS PIN
MI2558217654OtherBS PIN
MI2555012374OtherBCBS PIN
MI0N58330012Medicare PIN
MI0P48900001Medicare PIN